Healthcare Provider Details

I. General information

NPI: 1023004991
Provider Name (Legal Business Name): WILLIAM R HOGAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 DELHI AVE
CINCINNATI OH
45238-5214
US

IV. Provider business mailing address

5315 DELHI AVE
CINCINNATI OH
45238-5214
US

V. Phone/Fax

Practice location:
  • Phone: 513-922-2335
  • Fax: 513-922-4454
Mailing address:
  • Phone: 513-922-2335
  • Fax: 513-922-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1707
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: